| NPI | 1407033103 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN THOMAS SWANEK Director Of Patient Services 618-451-5722 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: IL 7001084) |
| Enumeration Date | 2008-01-24 |
| Last Update Date | 2021-03-19 |